Naslov
Hypertensive crisis in a 16-year old girl with accessory renal artery: a case report

Autori
Valent Morić, Bernardica ; Krpan, Tomislav ; Trutin, Ivana ; Josipović, Josipa ;

Izvornik
Archives of disease in childhood (0003-9888) 106 (2021), 2; 158-158

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
hypertensive crisis, children

Sažetak
Introduction The most common pattern of kidney vascularisation is a single renal artery originating from the abdominal aorta. However, in 20-30% of general population an accessory renal artery can be found being more frequently present (up to 80%) in patients with essential hypertension. A possible pathomechanism of hypertension is the impaired renal perfusion since the diametar of a single renal artery is usually larger than when multiple arteries are present. Whether an accessory renal artery could be a cause of hypertension is still controversial. Case Presentation We describe a case of a 16-year old girl who presented with hypertension crisis. She was previously healthy with no record of abnormal blood pressure (BP). At admission she reported nausea and severe headache while her BP was 220/120 mmHg. Her body mass index was normal and physical examination unremarkable. Initial workup showed normal renal function with normal serum electolytes and plasma glucose. Urin dipstick and urin toxicology screen were also normal. She had hypercholesterolemia and mild proteinuria but no signs of other target organ damage (electrocardiogram, echocardiography, fundoscopy and computed tomography of the brain were normal). Ambulatory blood pressure monitoring confirmed severe ambulatory hypertension. Further evaluation was aimed at determining the possible cause of secondary hypertension. Urine metanephrines, urinary free cortisol, plasma cortisol, ACTH and thyroid function tests were within reference ranges. High normal plasma renin with elevated plasma aldosteron led to a suspicion of renovascular hypertension. Magnetic resonance imaging revealed no pathology of the adrenal glands. Although renal ultrasonography with Doppler was normal, magnetic resonance angiography and later CT angiography showed two nonstenotic right renal arteries. Conclusion Although nonstenotic, an accessory renal artery should be considered as a possible cause of renovascular hypertension in children and adolescents.

Izvorni jezik
Engleski

POVEZANOST RADA